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Perioperative instrumental swallowing evaluation in adult airway reconstruction: A retrospective observational cohort study.
Haywood, M, Lovell, L, Roe, J, Clunie, G, Sandhu, G, Al Yaghchi, C
Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery. 2021;(6):1229-1236
Abstract
OBJECTIVES Airway reconstruction for laryngotracheal stenosis (LTS) encompasses several procedures. Dysphagia is a well-recognised sequela of LTS and airway surgery, however studies have employed mostly non-validated assessments post-operatively in small, heterogenous samples, perpetuating uncertainty around the contributions of LTS and its management to impaired deglutition. Consequently, considerable variation in LTS perioperative nutritional management exists. Our objective was to characterise baseline and post-operative dysphagia with instrumental assessment in an LTS cohort undergoing airway reconstruction and provide a gold-standard management framework for its management. DESIGN, SETTING, PARTICIPANTS AND MAIN OUTCOME MEASURES We performed a retrospective cohort study of adult airway reconstruction procedures from 2016-2020 at our quaternary centre. Patient background, LTS aetiology, procedure type, tube feeding duration, length of stay and serial Functional Oral Intake Scale (FOIS) and International Dysphagia Diet Standardisation Initiative (IDDSI) scores were noted. Baseline, post-operative day one and post-stent removal Fibreoptic Endoscopic Evaluation of Swallow (FEES) generated Penetration Aspiration Scale (PAS) scores. RESULTS Forty-four patients underwent forty-six reconstructions. Baseline incidence of penetration-aspiration was considerably higher than the general population and worsened in the immediate post-operative period, however FOIS and PAS scores generally returned to baseline by discharge. Post-operative FOIS correlated negatively with tracheostomy or airway stent placement. At discharge, 80% tolerated soft or normal diet and 93% were feeding tube independent. CONCLUSIONS We present the largest adult airway reconstruction cohort with instrumental swallow assessment perioperatively. LTS patients have a higher incidence of underlying dysphagia but swallowing tends to return to baseline with appropriate postoperative rehabilitation. Such practice may avoid the complications, costs and morbidity of prolonged nutritional support.
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Airway invasion in non-neurologically ill patients with dysphagia: Contributing factors and associated problems during swallowing process. A retrospective observational study.
Kim, KL, Park, GY, Kwon, DR, Kwon, DY, Kwak, SG, Cho, HK
Medicine. 2020;(45):e22977
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Abstract
Dysphagia can occur among patients receiving medical care despite having no history of neurologic disease. The current study aimed to investigate factors contributing to airway invasion among non-neurologically ill patients with dysphagia.This retrospective study included 52 non-neurologically ill patients who complained of swallowing difficulty and consulted the Department of Rehabilitation Medicine for videofluoroscopic swallowing studies between January 2018 and June 2019. Patients were then divided into 2 groups according to the presence of airway invasion (penetration or aspiration) based on videofluoroscopic swallowing study findings, with group 1 (n = 26) consisting of patients with airway invasion and group 2 (n = 26) consisting of those without airway invasion. Demographic information, functional ambulation ability within the past 3 months, presence of community acquired pneumonia (CAP), nutritional status, degree of dehydration, history of intensive care unit stay, history of endotracheal intubation, and videofluoroscopic dysphagia scale were reviewed.Patients with airway invasion exhibited decreased functional ambulation ability, greater incidence of CAP, and lower serum albumin concentration than patients without airway invasion (P < .05). Airway invasion among non-neurologically ill patients was significantly associated with functional ambulation ability [odds ratio (OR), 3.57; 95% confidence interval (CI), 1.14-11.19; P = .03], serum albumin concentration under 3.5 g/dL (OR, 4.90; 95% CI, 1.39-17.32; P = .01), and presence of CAP (OR, 5.06; 95% CI, 1.56-16.44; P = .01). Groups 1 and 2 had a videofluoroscopic dysphagia scale score of 37.18 and 16.17, respectively (P < .05). Moreover, bolus formation, tongue-to-palate contact, premature bolus loss, vallecular residue, coating of pharyngeal wall, and aspiration score differed significantly between both groups (P < .05).Airway invasion among non-neurologically ill patients was related to decreased functional ambulation ability, lower serum albumin concentration, and presence of CAP. The results presented herein can help guide clinical management aimed at preventing airway invasion among non-neurologically ill patients.
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Management of oral antiretroviral administration in patients with swallowing disorders or with an enteral feeding tube.
San, C, Lê, MP, Matheron, S, Mourvillier, B, Caseris, M, Timsit, JF, Wolff, M, Yazdanpanah, Y, Descamps, D, Peytavin, G
Medecine et maladies infectieuses. 2020;(7):537-544
Abstract
HIV infection has evolved into a chronic disease with comorbidities since the combination antiretroviral therapy era. Complications still occur and patients may need to be admitted to an intensive care unit. Acute respiratory failure is the first cause of these admissions, questioning the administration of solid oral dosage formulations. This issue is also observed in geriatric units where the prevalence of dysphagia is high and underestimated. The problem of antiretroviral administration is critical: altered solid oral dosage formulations and/or administration via enteral feeding tubes are sometimes the only option. The aim is to help manage antiretroviral treatment in unconscious or intubated patients and those with swallowing disorders who are hospitalized in intensive care units or geriatric units. This review provides information on the main antiretroviral regimens and on practical and legal aspects of manipulating solid oral dosage formulations and administration via enteral feeding tubes. Alternatives to the solid formulation are available for most of the 27 oral antiretrovirals available, or manufacturers provide recommendations for patients who are unable to swallow. Manipulation of solid oral dosage formulations such as crushing tablets or opening capsules and administration via feeding tubes are frequently reported but should be the last option for safety and liability issues. Before any off-label administration of a drug, physicians should consider alternatives to the solid oral dosage formulation and check whether the drug can be altered. Therapeutic monitoring is important in this particular setting as the pharmacokinetic profile of drugs is difficult to predict.
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Pureed diets containing a gelling agent to reduce the risk of aspiration in elderly patients with moderate to severe dysphagia: A randomized, crossover trial.
Kyodo, R, Kudo, T, Horiuchi, A, Sakamoto, T, Shimizu, T
Medicine. 2020;(31):e21165
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Abstract
GOALS The aim of this study was to evaluate the effectiveness of adding a gelling agent to pureed diets to prevent aspiration pneumonia in elderly patients with moderate to severe dysphagia. BACKGROUND Pureed diets are often used to reduce aspiration in patients with dysphagia. However, the ideal texture of a pureed diet to prevent aspiration pneumonia remains unclear. MATERIALS AND METHODS We prospectively conducted a randomized, crossover trial of pureed rice with or without a gelling agent in patients with moderate to severe dysphagia (ClincialTrials.gov number, NCT03163355). The primary outcome measure was pharyngeal residuals using an endoscopic scoring system. The secondary outcome was the sense of material remaining in the throat following swallowing. RESULTS Sixty two patients (58% men), mean age 83 ± 9 years with moderate to severe dysphagia were included. Residuals in the throat were significantly less likely with pureed rice with than without the gelling agent (median cyclic ingestion score (range); 1 (0-4) vs 2 (0-4); P = .001). Irrespective of the presence or absence of the gelling agent, the sense of material remaining in the throat was significantly less frequent in older patients (87 ± 7.6 vs 75 ± 9.1 years, P < .01; 86 ± 7.3 vs 75 ± 8.6 years, P < .01). CONCLUSIONS Pureed diets containing a gelling agent may reduce the risk of aspiration pneumonia possibly by decreasing pharyngeal residues in elderly patients with moderate to severe dysphagia.
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Outcomes of Vocal Fold Motion Impairment and Dysphagia after Pediatric Cardiothoracic Surgery: A Systematic Review.
Orzell, S, Joseph, R, Ongkasuwan, J, Bedwell, J, Shin, J, Raol, N
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2019;(5):754-763
Abstract
OBJECTIVE The objective of this study was to systematically review the literature regarding vocal fold motion impairment (VFMI), respiratory outcomes, and swallowing outcomes in children following congenital heart surgery (CHS). DATA SOURCES PubMed, Embase, Medline, and CINAHL databases. REVIEW METHODS Data sources were searched from inception to November 30, 2018. Studies that described recovery of VFMI and swallowing function following CHS were included, and a qualitative analysis was performed. RESULTS A total of 1371 studies were identified, of which 8 met inclusion criteria for VFMI and 5 met inclusion criteria for swallowing outcomes. Studies including patients who underwent isolate patent ductus arteriosus ligation were excluded. VFMI was present in 8% to 59% of subjects, and rates of recovery ranged from 9% to 96% at 6 months to 6 years of follow-up. Inability to maintain an oral diet occurred in 14% to 100% of subjects with VFMI and 11% to 61% without VFMI following surgery. Tolerance of an oral diet without tube feeding was present in 66% to 75% of subjects with VFMI and 88% to 100% without VFMI at 24 days to 3.2 years of follow-up. Limited data suggest that time to extubation is longer in VFMI subjects, but overall hospital length of stay and mortality may not be affected by VFMI status. CONCLUSIONS Data evaluating dysphagia and VFMI after CHS are limited. Most studies suggest significant improvement in swallowing function, while rate of recovery of VFMI is variable. Future prospective studies with standardized screening and follow-up are needed to better elucidate outcomes to help develop algorithms for identification and management of VFMI after CHS.
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Swallowing evaluation with videofluoroscopy in the paediatric population.
Re, GL, Vernuccio, F, Di Vittorio, ML, Scopelliti, L, Di Piazza, A, Terranova, MC, Picone, D, Tudisca, C, Salerno, S
Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale. 2019;(5):279-288
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Riceberry rice puddings: rice-based low glycemic dysphagia diets.
Suttireung, P, Winuprasith, T, Srichamnong, W, Paemuang, W, Phonyiam, T, Trachootham, D
Asia Pacific journal of clinical nutrition. 2019;(3):467-475
Abstract
BACKGROUND AND OBJECTIVES Swallowing difficulty and diabetes mellitus are common in the elderly. However, texture-modified foods suitable for blood sugar control are scarce. This study was aimed to identify texture, glycemic indices (GIs) and postprandial responses of original and high-fiber Riceberry rice puddings. METHODS AND STUDY DESIGN International Dysphagia Diet Standard Initiative (IDDSI)'s methods were used to determine texture. In vitro digestion was performed for estimating glycemic indices. A randomized cross-over controlled trial was conducted in twelve healthy volunteers. Original pudding, high-fiber pudding and white bread containing 40 g carbohydrate each were assigned in random sequence with twelve-day wash-out intervals. Plasma glucose concentrations were measured at 0, 15, 30, 60, 90, 120, 150, and 180 min after food intake. Individual GIs of puddings were calculated. RESULTS Original and high-fiber puddings were classified as IDDSI level 3 (liquidized) and 4 (pureed), respectively. The in vitro estimated GIs were 51 for original and 48 for high-fiber puddings. Clinical trial showed rapid kinetics (peaked at 30 min) but lower postprandial responses of both puddings, compared to white bread (peaked at 60 min). The adjusted GIs for original and high-fiber puddings were not significantly different (at 41±7.60 and 36±6.40, respectively). CONCLUSIONS Addition of fiber to the original pudding changed physical properties but not significantly reduced the GI. Original and high-fiber Riceberry rice puddings could be low-GI dysphagia diets, which may be useful for step-wise swallowing practice from IDDSI level 3 to 4 for those who also required blood sugar control.
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Effect of an Oral Health Programme on Oral Health, Oral Intake, and Nutrition in Patients with Stroke and Dysphagia in Taiwan: A Randomised Controlled Trial.
Chen, HJ, Chen, JL, Chen, CY, Lee, M, Chang, WH, Huang, TT
International journal of environmental research and public health. 2019;(12)
Abstract
No previous studies have evaluated an oral health programme, before swallowing therapy, in patients with stroke and dysphagia in Taiwan. This randomised controlled trial evaluated the effect of an oral health programme (i.e., sputum assessment, Bass method-based tooth brushing, and tooth coating with fluoride toothpaste) before swallowing therapy. Sixty-six patients with stroke (23 female, 43 male) in our rehabilitation ward, who underwent nasogastric tube insertion, were assigned randomly to an oral care group (n = 33) and a control group (n = 33). Demographic data, oral health assessment, Functional Oral Intake Scale (FOIS) scores, Mini-Nutritional Assessment-Short Form (MNA-SF) scores, and nasogastric tube removal rates were compared between groups. We evaluated outcomes using generalised estimating equation analysis. Three weeks post-implementation, the oral care group had significant oral health improvements relative to the control group (95% CI =-2.69 to -1.25, Wald χ2 = 29.02, p < 0.001). There was no difference in the FOIS (95% CI = -0.16 to 0.89, Wald χ2 = 1.86, p>0.05), MNA-SF (95% CI = -0.35 to 0.53, Wald χ2 =-0.17, p>0.05), and nasogastric tube removal (p>0.05) between groups. The oral care group had a higher, but non-significant FOIS score (3.94 vs 3.52) (p > 0.05). Routine oral health programmes implemented during stroke rehabilitation in patients with dysphagia may promote oral health and maintain oral intake.
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Nutritional support dependence after curative chemoradiotherapy in head and neck cancer: supplementary analysis of a phase II trial (JCOG0706S1).
Imamura, Y, Kiyota, N, Ogawa, G, Akimoto, T, Fujii, M, Hanai, N, Iwae, S, Monden, N, Matsuura, K, Onozawa, Y, et al
Japanese journal of clinical oncology. 2019;(11):1009-1015
Abstract
OBJECTIVES To explore the risk factors of laryngo-esophageal dysfunction-free survival and nutritional support dependence over 12 months in patients with unresectable locally advanced head and neck carcinomas who received chemoradiotherapy in a phase II trial of JCOG0706 (UMIN000001272). METHODS Forty-five patients received radiation therapy for a total of 70 Gy/35fr concurrently with S-1 and cisplatin. Risk factors of laryngo-esophageal dysfunction-free survival and nutritional support dependence over 12 months were analyzed using Cox regression models and logistic regression models, respectively, with consideration to patient laboratory data just before chemoradiotherapy. Radiation fields were reviewed to analyze the relationship between the extent of the irradiated field and functional outcome. RESULTS With a median follow-up period of 3.5 years, 3-year laryngo-esophageal dysfunction-free survival was 48.9%. For laryngo-esophageal dysfunction-free survival, hazards ratio of 2.35 in patients with nutritional support at registration (vs. without nutritional support; 95% confidence interval 0.96-5.76). For nutritional support dependence over 12 months, odds ratio was 6.77 in patients with hemoglobin less than the median of 13.4 g/dl (vs. higher than or equal to the median; 95% confidence interval 1.24-36.85) and was 6.00 in patients with albumin less than the median of 3.9 g/dl (vs. higher than or equal to the median; 95% confidence interval 1.11-32.54). Primary sites in disease-free patients with nutritional support dependence over 12 months were the oropharynx (N = 2) or hypopharynx (N = 1), and all pharyngeal constrictor muscles were included in irradiated fields with a curative dose. CONCLUSIONS This supplementary analysis showed that pretreatment severe dysphagia requiring nutritional support, anemia and hypoalbuminemia might have a negative prognostic impact on long-term functional outcomes after curative chemoradiotherapy in head and neck cancer.
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Validity and reliability of the French version of Eating Assessment Tool (EAT-10).
Lechien, JR, Cavelier, G, Thill, MP, Huet, K, Harmegnies, B, Bousard, L, Blecic, S, Vanderwegen, J, Rodriguez, A, Dequanter, D
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2019;(6):1727-1736
Abstract
OBJECTIVE To develop a French version of the Eating Assessment Tool (Fr EAT-10) and to assess its internal consistency, reliability and clinical validity. METHODS Fifty-six patients referred in the Swallowing Clinics of CHU Saint-Pierre Hospital (Brussels) and EpiCURA hospital (Ath, Belgium) for dysphagia were enrolled and completed fiberoptic endoscopic evaluation of swallowing and videofluoroscopy. Seventy-three asymptomatic subjects were included in the study. To assess reliability, Fr-EAT-10 was completed twice within a 7-day period. Validity was assessed by comparing Fr-EAT-10 scores with the scores of dysphagia handicap index (DHI) in all individuals. Normative value of EAT-10 was calculated and the receiver operating characteristic (ROC) curve was used to determine the best Fr-EAT-10 threshold associated with aspiration. RESULTS Fifty-two patients completed the study. Cronbach's alpha was 0.95 indicating a high internal consistency. Test-retest reliability was high in the entire cohort (rs = 0.921). The correlation between Fr-EAT-10 total scores and DHI was high (rs = 0.827) indicating a high external validity. Patients had a significant higher score of Fr-EAT-10 than the controls (p < 0.001) exhibiting a high internal validity. The analysis of normative data reported that a score of Fr-EAT-10 > 3 should be considered as abnormal. The correlation between Fr-EAT-10 and the occurrence of aspiration is significant (rs = 0.327, p < 0.05). According to the ROC curve; aspirations need to be highly suspected for patients with Fr-EAT-10 ≥ 17. CONCLUSION The Fr-EAT-10 developed in this study is a reliable and valid self-administered tool in the evaluation of dysphagia in French-speaking patients.